Pharmacy
Workers’ Compensation Pharmacy Benefit Management
At Preferred Medical, we take a proactive approach to pharmacy benefit management. Our individualized and comprehensive strategies help payers and their claims professionals make a significant impact on clinical and financial outcomes.
Why Choose Preferred Medical for Pharmacy Services?
Responsive Team
Our tenured pharmacy experts are always available to assist you.
Proactive Approach
We help you get in front of high-risk, high-dollar claims.
Clinical Excellence
Our drug utilization review programs maximize clinical outcomes and help ensure only appropriate medications are approved.
Cost-Effective Solutions
Robust in-network strategies lead to significant cost savings and fewer out-of-network bills.
Simplified Administration
Our claims examiner portal simplifies pharmacy management with real-time tracking, comprehensive data, and automated workflows, enabling informed decisions on prior authorization medications.
Data-Driven Insights
Customized reporting and analytics provide actionable insights and guide decision-making.
Jurisdictional Expertise
We navigate complex state regulations so you don’t have to.
Our Comprehensive Pharmacy Services
Our network includes all major chains and most independent and specialty pharmacies, ensuring convenient access for recovering employees nationwide. This extensive coverage significantly reduces out-of-network pharmacy bills.
We ensure recovering employees receive immediate access to necessary medications right after an injury, without delays. Available as both print and text message, these temporary first fill cards allow workers to fill prescriptions at any participating pharmacy within our extensive network, with no out-of-pocket expense.
We offer individualized point-of-sale formularies that integrate medical necessity and cost containment rules. These can be state-mandated, workers’ compensation injury specific, client-customized, or claim-specific.
Our clinical team helps you address complex pharmacy regimens, protect injured workers, and speed recovery:
- Proprietary clinical alerts and analysis to identify potential issues associated with high-risk, high-cost claims for targeted intervention
- Direct access to in-house pharmacists for consultation and support
- Educational outreach to prescribers and injured workers
- Expert clinical advisory services to guide prior authorization decisions
- Comprehensive claim drug analysis and medication file reviews
- Medication peer outreach for complex cases
We make it easier to keep bills in-network through:
- User-friendly, workers’ compensation focused Home Delivery program
- Thorough review of all bills for eligibility and accuracy
- Application of appropriate network or state fee schedule discounts
- Adjustment out-of-network claims to network pricing when unidentified coverage is the cause, contacting the pharmacy and employee to ensure future fills stay in-network
- Reduction of third-party bills to network rates when possible
